elizabeth d. herman

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on being sick abroad

I’m a strong believer in the power of sleep and ibuprofen. Headache? Head to bed early and pop a couple pills. Back pain? Same deal. Fever? Again, early night and two tablets.

But after my latest fever stint hadn’t disappeared after five days of first rearing its ill-timed head – Eid break, with lots of work on the to-do list – every nurse I had called back home had switched from that rest-and-ibuprofen tune to one of getting myself to a doc, pronto.

And after a slew of tests and a few days of waiting, back came a positive typhoid test and a doctor’s order to be admitted to the hospital – immediately – for a hefty dose of intravenously-administered antibiotics.

Typhoid. One of the many vaccines I had gotten sometime in the past few years, part of the laughably long list for which the Resident Nurse at Somerville’s Harvard Vanguard had called me a pin cushion. And one that is – take note travelers – only 50 to 80 percent effective. Meaning not very. And especially not during South Asia’s monsoon season, when the prevalence of diseases like dengue and malaria and hepatitis and, you guessed it, typhoid tend to spike.

So after nearly two weeks of trying to navigate this whole sick abroad thing, here’s a few notes that I’ve collected on the experience thus far, for any expats or long-term travelers or others who might just be interested in knowing what negotiating healthcare abroad is like.

A quick disclaimer – I am not a professional or expert on any of these things (you knew that!), and these are just a few of my own personal recommendations, things I would have found helpful in knowing a couple weeks ago. Hope you find them to be so, too.

1. Have a medically-knowledgable someone you can call back home. Whether it’s your general practitioner, or your lovely aunt who happens to be the world’s best nurse (thanks, Auntie Mariann!), having someone who knows more about health and sickness than you do is not just reassuring, but can be downright vital in deciding what’s the best course of action to take. Plus, it just makes you feel better knowing there’s someone on the other side of the line.

2. Go into the doctor sooner rather than later. Yes, it’s a pain, especially if there’s traffic and it’s inefficient and takes all day. But having test done and results analyzed will (likely, hopefully) make for a faster diagnosis and less stress for you and all interested parties. Maybe it’s nothing! But maybe it’s not. And for some illnesses, timing really is everything, and the sooner you can catch it the better.

3. Don’t just go to any doctor. If you’re really sick, it’s worth calling your health care provider from home (or a family member’s, or a friend’s if you’ve given yours up) and seeing if they can refer you to someone in their international network, if they have one. Otherwise, do some research online or ask around locally before making an appointment with someone. Not all doctors are created equal, and the right doc can mean the difference between a real diagnosis and an order to just go home and sleep it off. Which in some cases, you can’t.

4. Come with a copy of what your ‘normal’ blood results are, if possible. Good for comparison’s sake, as not all reference ranges (the ‘normal values’ you should fall within on diagnostic tests) are the same for all people all the time. A lot of healthcare providers now have online centers at which you can create an account and track your health history; check and see if yours does, and if they do, set yours up and get tests and vaccine information from as far back as possible uploaded.

5. Get international health insurance. Just do it. If you’re abroad in a disease-prone place for long enough, there’s a pretty good chance that you’re going to get sick, and it’s probably going to pay for itself in the end. So. Just do it.

6. If you have a bacterial infection, have a test done to see which drugs it is susceptible to. I think it’s called a ‘panel’, and it’s important in determining what treatment you need. For example, the South Asian strain of typhoid is resistant to Ciproflaxin (known to most as cipro), the antibiotic of choice prescribed by most doctors back in the US for most all bacteria-related travel ails. Which means it just wouldn’t work on the strain of the disease here, and so you need a different drug. Most doctors will automatically test for drug susceptibility when they do your bacterial culture, but it’s worth asking for it just to be sure.

Which brings us to…

7. Ask questions. And don’t feel dumb or embarrassed for doing so. For me personally, just being informed makes me feel better, and most doctors will be quite understanding – and even amused – at the string of questions fired off by a wide-eyed foreigner. They know you’re far from home, they know you’re not used to this, and most likely they know the answer to what you’re wondering about.

And that’s all I can think of for now. There is far more advice to give, and much of this many would consider excessive, but again, a few extra queries and a bit more info can’t hurt, ya?

Time in the hospital has put me in the market for entertainment – music or emails or blogs or articles or whathaveyou – so if you have anything good, or have been feeling like writing an email, feel free to send it over my way. And thanks to everyone who has been checking in from so many miles away, it absolutely brightens days in Room 2435.